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<br />ovr~IVEQ <br />AUG 212001 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Washington County <br />bI-1994-077 <br />Nickell Gravel Pit <br />August 25, 2007 <br />$791.00 (Due on or before your anniversary date) <br />Washington <br />Division of Reclamation, <br />Mining and Safety <br />According_to_C.R.S.. 34-32.5~16_oc C.RS.. 34_32-L16,_each_year,_on the_annixersary date of the permit, an _ <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous vear and no <br />new changes to the previous year's mau are necessary, then no new mau is required, urovided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Board of County Commissioners CF.PR.contact_last_name <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Washington County <br />150 Ash <br />Akron, CO 80720 <br />(970) 345-2701 <br />(970)345-2702 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />l~ /~ <br />v Si afore f^Corporate fficer Owner, or Des' ee <br />S-- ~~-a ~ <br />Date <br />M:~PEAMI7IMASTERDOCUMEMS~M-AF-04 <br />